Provider Demographics
NPI:1982909313
Name:ELISABETH R WARNER
Entity Type:Organization
Organization Name:ELISABETH R WARNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-535-6043
Mailing Address - Street 1:35 HEARTBREAK RD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2584
Mailing Address - Country:US
Mailing Address - Phone:978-535-6043
Mailing Address - Fax:978-535-6047
Practice Address - Street 1:35 HEARTBREAK RD
Practice Address - Street 2:UNIT 3
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2584
Practice Address - Country:US
Practice Address - Phone:978-535-6043
Practice Address - Fax:978-535-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN215569363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty